ABSTRACT
This study was designed to determine the Occupational Stressors and Coping strategies of nurses in Tertiary Hospitals in Enugu State. The study sought answers to four research objectives and tested seven hypotheses. The population of study consisted of four hundred and twenty-two nurses in tertiary hospitals in Enugu state. They were sampled using stratified proportionate and clustered sampling techniques. Fifty eight (68) question items questionnaire (demographics variables, level of stress questions and Ways of Coping Questionnaire ) was the instrument used for the data collection. The instrument was validated by three experts and two personnel managers and Cronbach alpha Reliability coefficient was used to determine the internal consistency of the instrument. The instrument yielded a reliability coefficient of 0.88 and 0.85 respectively. Frequency counts, percentages, mean statistics and standard deviations were used to answer the research objectives while seven hypotheses were tested using t-test and analysis of variance (ANOVA) at 0.05 level of significance. The major findings of the study showed that almost all the respondents were females (92.25%), a greater percentage (85.75%) were married, also majority (95%) had no training on occupational stress management. The level of stress experienced by nurses across the four hospitals are the same with work environment as the greatest stressor. The most used strategy by respondents in the 4 hospitals was planful problem solving and problem focused coping while the least used strategy was the escape-avoidance. There is significant difference in the use of coping strategies (EFC and PFC) across the 4 hospitals. Respondents from ESUT Teaching Hospital differed from respondents in the other hospitals in the use of EFC, while respondents from NOHE differed from others in the use of PFC. The use of EFC depends on the respondents’ educational status. The use of coping strategies (PFC and EFC) is same for both the married and single. There is no significant difference in the use of coping strategies (PFC and EFC) by the respondents across their ages and their years of working experience. Use of EFC is same across the professional ranks while the use of PFC varies across the ranks. Respondents in the rank of ADNs showed the most use of the 2 coping strategies (PFC and EFC) while NO1 showed the least use of EFC and PFC. The study has implication for the nurses, nurse administrators and hospital managers. Work environment should be maintained in such a way that it will be conducive for the nurses to perform their jobs. Nurses should aspire to acquire higher degrees in nursing. Periodic assessment of nurses stress levels should be done and actions put in to reduce, alleviate or aid coping among nurses. Senior nurse should coach younger ones on better ways of
coping with stress.
CHAPTER ONE
INTRODUCTION
Background to the Study
Work is an essential need for everyone. It is estimated that over 75% of adult’s non-sleeping time is devoted to job activities and people find satisfaction and personal identity by means of their employment. Among life events the workplace stands out as a potentially important source of stress purely because of the amount of time spent in this setting (Scott, 2012). Employees are exposed to tension, frustration and anxiety as they go about the task assigned to them. The negative effect of work on an individual is referred to as occupational stress (OS).
Nakasis and Ouzoni (2008) defined occupational Stress (OS) as the harmful physical and emotional responses that occur when the requirements of the job do not match the resources, capabilities and needs of the worker. Occupational stress is also referred to as a pattern of emotional, cognitive, behavioral and physiological reactions to adverse and noxious aspects of work content, work organization and work environment (European Commission, 2008). Occupational stress is a condition arising from the interaction of people and their job and is characterized by changes within the people that force them to deviate from normal functioning. OS arises when the individual normal coping responses cannot be found (that is, the individual is unable to cope anymore) and as such not able to get along with his job resulting in propensity to leave the organization, absenteeism to mention a few. OS is also seen on a process in which a professional’s attitude and behavior change in negative ways in response to job stressors.
OS is a growing global concern as all countries, profession and all categories of workers, families and societies are affected by occupational stress. Over the past two decades there has been a growing belief that the experience of stress at work has undesirable effects, both on the health of the employee and the effectiveness of the organization. Stress is second in frequency health problem with regards to occupational environment (Moustaka, Antoniadon, Malliarrou, Zanthos, Kiriaki and Constatinidis, 2010). In the UK, occupational stress is estimated to be the largest occupational health problem (Edward & Barnard, 2008). World Health Organization (WHO) has viewed it as a world wide epidemic as it has recently been observed to be associated with 90% of visits to physicians.
Occupational stress has been associated with chronic health problems like cardiovascular diseases, musculoskeletal disorders, physical injuries and cancers (Alves, 2005). Significantly, it reduces brain functions such as memory, concentration and learning and also impairs the immune system, all of which are central to effective performance at work. Occupational stress adversely affects performance in the workplace due to factors such as absenteeism, lower productivity, employees’ turnover and industrial accidents. Figure given by the Health and Safety Executive (2001) in the UK suggests that stress related medical problems are responsible for the loss of 6.5 million working days each year which in turn cost organizations in UK around three hundred and seventy (370) million dollars (about five hundred and eighteen million US dollars) (Sutherland & Cooper, 2002). US business and industry lose about five hundred and fifty (550) million working days annually because of absenteeism and 54% of these cases are stress – related (Lin, 2007).
The problem of occupational stress is not limited to these regions. Although, there is paucity of data as regards the impact of occupational stress in the sub-region of Africa and Nigeria to be precise, it has been defined as a “global epidemic” by the United Nations International Labor Organization.
Occupations in the field of human services are considered to be high stress occupations dealing with diverse social as well as individual problems. OS is a major occupational health problem for health care professionals especially nurses. Nurses provide care for three (3) types of clients: individuals, families and communities. This involves, promoting health and wellness, preventing illness, restoring health and caring for the dying. Nizamd et al (2006) stated that caring for individuals, families, groups, population or entire communities with multiple, complex and distressing problems can be overwhelming for even the most experienced practitioner. Nurses encounter complex and stressful conditions due to special demands of their profession which enhances their vulnerability to occupational stress (OS). Stress among nurses is an endemic problem and nursing is known to be stressful through out the world (Onasoga, Ogbebor and Ojo, 2013). Nad (2009), stated that nursing is emotionally, physically and psychologically demanding. Many nursing tasks are by normal standards distasteful and disgusting, others are often degrading while some are simply frightening.
Most studies on occupational stress management have viewed it as a response to a stressor. Occupational stress management strategies refer to measures initiated by an individual or organization that aim at reducing the presence of work related stressor or assisting individuals to minimize negative outcomes of exposure to these stressors. It could be referred to as physical and psychological resources used to counter the effects of occupational stress or to cope with the stress. In the present study, coping is synonymous to occupational stress management. Coping has been considered as a very crucial element in the stress literature as individuals under stress can use various coping strategies to buffer, minimize or tolerate the effects of the stressor (Lin, 2007). It could also be seen as effort, whether cognition or action that people use to cope with environmental stressors. Such efforts could be problem focused or emotion focused strategies. The strategies include; confrontive coping, distancing, self-controlling, seeking social support ,accepting responsibility, escape-avoidance, planful–problem solving and positive reappraisal (Lambert and Lambert,2008).Problem focused strategies are highly action focused and involve altering or managing the problem that is causing the stress while emotion focused strategies refer to those strategies that help the individual reduce the negative emotional response associated with stress such as embarrassment, fear, anxiety to mention a few. Studies have shown evidence that use of coping strategies can have beneficial effect on both the employer and the employees, enhancing work satisfaction, reducing rate of absenteeism and turn over and also workplace related tension (Lin, 2007; Lambert & Lambert,2008).
In the previous studies, it was reported that nurses used mostly problem-focused coping rather than emotion-focused coping strategies and that nurses used a variety of coping strategies in order to deal with numerous workplace stressors (Chang et al., 2006; Tyson & Pongruengphant, 2004; Xianyu & Lambert, 2006; Welbourne et al., 2007).
Studies have shown that some demographic variables have significant association with coping strategies adopted by nurses (Jose & Bhat, 2013; Payne, 2001). Some of these variables are age, marital status, married status, years of working experience, experience in current area, area of work and daily working hours. Each coping strategy function independently in stressful situations, the type of strategy adopted largely depends on the specific profile of the individual’s stress perception and demographic characteristics (kariv & Heiman, 2013).
It has been established that nursing is stressful (Nad,2009; Papageorgiou, Karabetsou, Nikolakou & Paylakou, 2007) but work on how nurses cope or manage occupational stress and the demographic determinants are rather few and inconclusive. In order to fill this gap in knowledge, this study, therefore, investigated the coping behavior of nurses to work-related stress in tertiary hospitals in Enugu State.
Papageorgiou, Karabetsou, Nikolakou & Paylakou, (2007), noted that nurses are one of the most vulnerable professional groups to occupational stress as they often encounter stressful situation in their human service profession. Nursing could be described as a job that requires expenditure of energy on many levels. Physical demands of the job could result in many aches, strains and pains. Mentally, the nurse is required to make calculations for medications and to respond professionally to questions of patients and relatives. Emotionally, she is expected to be clothed with empathy to provide the needed care to her clients. All these notwithstanding, the nurse is still confronted with issues like resource constraints, poor staff support and organizational change to mention few. These also add to the energy expended by the nurse.
The physiological, mental and emotional harm caused by stress can adversely affect their performance (example in medication errors). A nurse under stress will be indifferent to patient’s demand. More so, she may be withdrawn, behaves negatively, most often absents herself from work and has a desire to quit the profession (Papageorgion, 2007). The major concern of this work is “how do nurses cope or handle stress at the workplace and what are those demographic variables that determine coping strategies used by them?” This study intends to find answers to the above questions.
The purpose of the study is to find the demographic characteristics of nurses as a determinant of how they manage occupational stress in tertiary hospitals in Enugu State. Specifically, the objectives of the study are to:
Hypotheses
The following hypotheses guided the study.
4 There is no significant difference in the mean ratings of coping strategies used by the nurses in the tertiary hospitals with respect to their years of experience.
5 There is no significant difference in the mean ratings of coping strategies, used by the nurses in the tertiary hospitals with respect to their ages.
6 There is no significant difference in the mean ratings of coping strategies used by the nurses in the tertiary hospitals with respect to their martial status
7 There is no significant difference in the mean ratings of coping strategies used by the nurses in the tertiary hospitals with respect to their professional ranks.
Research is the best way to find solutions to nursing problems and to set standard for nursing practice. This study is of utmost importance as it will provide a valid information on how nurses in the tertiary hospitals manage stress at work. Thus, equipping the health institutions, government, non-governmental organizations and other stakeholders in the health sectors with the right information to enable them organize training, seminars, workshop on interventions to handle stress at work (both at the organizational level and at the individual level). These interventions will assist the nurses to be more effective in managing stress at work; improving and promoting their health, job satisfaction while reducing the physiological, psychological and behavioral, consequences of occupational stress, ensuring the delivery of quality nursing care with an enhanced patient outcome.
Findings from this study will provide literature for further studies in this area of research.
The study was delimited to the occupational stressors and coping strategies among all carders of nurses in the clinical areas in tertiary hospitals (University of Nigeria Teaching Hospital, Ituku-Ozalla; National Orthopaedic Hospital Enugu; ESUT Teaching Hospital Teaching Hospital Enugu and Neuropsychiatric Hospital, Enugu),all in Enugu,Enugu State. This study was focused only on the stress coping measures used by the nurses at work and the demographic variables( educational status,years of working experience,age,marital status and professional rank).
Occupational Stressors: Conditions or events at work that cause stress for the nurse.
Occupational Stress: A state of physical, emotional and mental exhaustion perceived by the nurse and characterized by physical depletion, feelings of helplessness, chronic fatigue and development of negative attitude towards work.
Management of Occupational Stress: This included problem focused coping strategies and emotion focused strategies used by nurses to cope with stress at work.
Problem Focused Strategies: Strategies that target the problem or stressful situation. Examples, “I did something risky to solve the problem’’, “I got professional help’’, “I lectured myself’’, “I made a plan of action and followed it’’.
Emotion focused strategies: Strategies that target the negative emotional responses associated with stress. Examples “I tried to forget the problem’’, “I exercised’’ “I prayed’’, “I tried to make myself feel better by eating’’.
Demographic variables; age, educational status, rank, marital status, years of experience.
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